Med Surg Exam 3
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: A). rapid-acting insulin only. B) short- and intermediate-acting insulins. C) intermediate- and long-acting insulins. D) short- and long-acting insulins.
A). rapid-acting insulin only. A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.
During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate?
"Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse." Anticipating and planning interventions is a cornerstone of end-of-life care. The nurse encourages communication and anticipatory grieving by using open-ended statements such as "Tell me. . . ." Effective communication techniques include the avoidance of closed-ended statements and giving advice.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A) "Don't take your insulin or oral antidiabetic agent if you don't eat." B) "Follow your regular meal plan, even if you're nauseous." C) "Test your blood glucose every 4 hours." D) "It's okay for your blood glucose to go above 300 mg/dl while you're sick."
"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery?
"Tumor removal will promote comfort." Palliative surgeries, such as bowel resection, may be performed to promote comfort by relieving pain and pressure on organs within the abdominal cavity. Primary treatment refers to surgery that is likely to provide a cure, which is not likely in metastatic disease. With metastasis, primary tumor removal does not prevent further tumor growth in distant sites. The diagnosis of colon cancer with metastasis suggests cell pathology has already been determined.
A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply.
-Red blood cell (RBC) count of <4.0 million/mcL -Positive antinuclear antibody (ANA) -Positive C-reactive protein (CRP) Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression.
Which of the following statements about osteoporosis is true?
A family history of osteoporosis increases the risk of the condition
The side effect of bone marrow depression may occur with which medication used to treat gout? a.)Allopurinol b) Prednisone c) Colchicine d) Probenecid
A) Allopurinol A client taking allopurinol needs to be monitored for the side effects of bone marrow depression, vomiting, and abdominal pain.
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? A) Facial erythema, pericarditis, pleuritis, fever, and weight loss B) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers C) Weight gain, hypervigilance, hypothermia, and edema of the legs D) Hypothermia, weight gain, lethargy, and edema of the arms
A) Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers.
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? A) Increase his intake of sodium until the GI symptoms improve. B) Increase his intake of potassium until the GI symptoms improve. C) Increase his intake of glucose until the GI symptoms improve. D) Increase his intake of calcium until the GI symptoms improve
A) Increase his intake of sodium until the GI symtpoms improve The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia
A) Infection When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression and infection.
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2- month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine
A) Liver function tests (LFTs) Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome?
Administer 2 to 3 L of IV fluids rapidly Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly ordered fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution.
A health care provider orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?
An above normal anti-deoxyribonucleic acid(DNA)test Laboratory results specific for SLE include an above-normal anti- DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE.
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? A) Risk for peripheral neurovascular dysfunction B) Excess fluid volume C) Hypothermia D) Ineffective airway clearance
B) Excess fluid volume The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The patient is not at risk for neurovascular dysfunction or a compromised airway.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: a) Bradypnea b) Paresthesia c) Hypotension d) Hypothermia
B) Paresthesia Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis? A) ESR B) Red blood cell count C)Uric acid D)Creatinine
B) Red blood cell count There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.
The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic? A) The possibility of precipitous weight gain B) The need for lifelong steroid replacement C) The need to match the daily steroid dose to immediate symptoms D) The importance of monitoring liver function
B) The need for lifelong steroid replacement Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the patient and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except: a) Doxorubicin (Adriamycin) B) Fluorouracil (Adrucil) C) Mitoxantrone (Novantrone) D) Bleomycin (Blenoxane)
B) fluorouracil (Adrucil) Fluorouracil (Adrucil) is an antimetabolite.
In people with osteoporosis, compression of the vertebrae in the upper back can cause A) fluorosis B) kyphosis C) scoliosis D) spina bifida.
B) kyphosis Kyphosis occurs due to the collapse of vertebral bodies.
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.
A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A) Ensuring adequate rest B) Limiting exposure to sunlight C) Limiting intake of alcohol D) Smoking cessation
C) Limiting alcohol intake Alcohol and red meat can precipitate an acute exacerbation of gout
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
A hospitalized client with terminal heart failure is nearing the end of life. The nurse observes which of the following breathing patterns?
Cheyne-Stokes Cheyne-Stokes breathing is characterized by a regular cycle where the rate and depth of breathing increase, then decrease until apnea occurs. The duration of apnea varies but progresses in length. This breathing pattern is associated with heart failure, damage to the respiratory center in the brain, or both.
Which condition may contribute to hyperparathyroidism?
Chronic renal failure Explanation: Because failing kidneys can't convert vitamin D, the serum calcium level declines. Parathyroid hormone release increases, causing hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Serum calcium level may rise as a result of hyperparathyroidism, so it isn't a contributing factor. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
A nurse should expect to administer which medication to a client with gout?
Colchicine A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation.
A nurse is reviewing the care of a client who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug? A) Calcitonin B) Prednisone C) Aspirin D) Cyclobenzaprine
D) Cyclobenzaprine Short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain.
A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? A) Extreme anorexia B) Severe asthenia C) Starvation D) Profound protein loss
D) Profound protein loss Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? a. Suppression of the bone marrow b. Enhance action of the chemotherapy c. Decrease the need for additional adjuvant therapies d. Shorten the period of neutropenia
D. Shorten the period of neutropenia Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.
Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings?
Decreased platelets Thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.
Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?
Disease-modifying anti-rheumatic drugs (DMARDs) Explanation:Once a diagnosis of RA has been made, treatment should begin with DMARDs. NSAIDs are used for pain and inflammation relief but must be used with caution in long-term chronic diseases due to the possibility of gastric ulcers. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms.
When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following?
Inadequate secretion of parathormone In hypoparathyroidism, there is an increased blood phosphate. Blood calcium is decreased, and there is a decreased renal excretion of phosphate. The secretion of parathormone is inadequate.
An older adult female patient is diagnosed with osteoporosis.Which risk factor should the nurse recognize as a contributing to this disease?
Lack of vitamin D A patient with a history of decreased levels of vitamin D will be at a risk of developing osteoporosis. This is a modifiable risk factor for osteoporosis.
A client has received several treatments of bleomycin. It is now important for the nurse to assess a) Urine output b) Lung sounds c) Skin integrity d) Hand grasp
Lung sounds Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.
A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem?
Rheumatoid arthritis (RA) In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone.
Which condition is the leading cause of disability and pain in the elderly? a) Rheumatoid arthritis (RA) b) Systemic lupus erythematous (SLE) c) Scleroderma d) Osteoarthritis (OA)
d) Osteoarthritis (OA) OA is the leading cause of disability and pain in the elderly.
A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient? A)Do not eliminate insulin when nauseated and vomiting. B)Report elevated glucose levels greater than 150 mg/dL. C)Eat three substantial meals a day, if possible. D)Reduce food intake and insulin doses in times of illness.
A)Do not eliminate insulin when nauseated and vomiting. Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread
A, B, E Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A) Hyponatremia B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia
C) Hypocalcemia Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? A)I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels. B)I'll try to be as physically active as possible between flare-ups. C)I'll make sure to monitor my body temperature on a regular basis. D)I'll stop taking my steroids when I get relief from my symptoms.
C) I'll make sure to monitor my body temperature on a regular basis. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the patient.
A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? A) Side-lying with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowler with the head supported on two pillows D) Supine, with a small roll supporting the neck
C) Semi-Fowler with the head supported on two pillows When moving and turning the client, the nurse carefully supports the client's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows.
A nurse is providing a class on osteoporosis at the local center for older adults. Which statement related to osteoporosis is most accurate? A) High levels of vitamin D can cause osteoporosis. B) A nonmodifiable risk factor for osteoporosis is a person's level of activity. C) Secondary osteoporosis occurs in women after menopause. D) The use of corticosteroids increases the risk of osteoporosis.
D) The use of corticosteroids increases the risk of osteoporosis. Corticosteroid therapy is a secondary cause of osteoporosis when taken for long-term use. Adequate levels of vitamin D are needed for absorption of calcium. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.
A client is recovering from an attack of gout. What will the nurse include in the client teaching? A) Weight loss will reduce purine levels. B) Weight loss will reduce inflammation. C) Weight loss will increase uric acid levels and reduce stress on joints. D) Weight loss will reduce uric acid levels and reduce stress on joints.
D) Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.
What is carcinoma insitu?
abnormal cells that look like cancer cells under a microscope are found only in the place where they first formed and haven't spread to nearby tissue.- These in situ cells are not malignant, or cancerous but these cells may become cancerous and spread into nearby normal tissue.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? a) Nausea and vomiting b)Stomatitis c)Extravasation d)Bone pain
c) Extravasation The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action. The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?Nausea and vomitingStomatitisExtravasationBone pain
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? a) Elevated serum creatinine b)Elevated urea and nitrogen c)Hyperphosphatemia d)Hyperkalemia
c) Hyperphosphatemia Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? a) It interferes with deoxyribonucleic acid (DNA) replication only. b) It interferes with ribonucleic acid (RNA) transcription only. c) It interferes with DNA replication and RNA transcription. d) It destroys the cell membrane, causing lysis.
c) It interferes with DNA replication and RNA transcription. Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a) Withholding fluids for the first 4 to 6 hours after chemotherapy administration b) Serving small portions of bland food c) Encouraging rhythmic breathing exercises d) Administering metoclopramide and dexamethasone as ordered
d) Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells? a) Probenecid (Benemid) b) Cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) c) Thioguanine (6-thioguanine, 6-TG) d) Leucovorin (citrovorum factor or folinic acid [Wellcovorin])
d) Leucovorin (citrovorum factor or folinic acid [Wellcovorin]) Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity.-Leucovorin is administered with Methotrexate to protect normal cells, which methotrexate could destroy if given alone.
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening? a) Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor b) Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse c) Pulse 72 beats/minute, irregular; patient confused and agitated d) Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankle
d) Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.
Symptoms that indicate a client is hours before dying or in the actively dying phase
irregular pulse and mottled extremities. The client may also have periods of apnea that last longer than 40 seconds.
The blood test of osteomalacia will show
• Decreased serum calcium or phosphorus • Decreased serum vitamin D • Elevated alkaline phosphatase